序贯机械通气策略治疗重症哮喘的临床研究

Clinical Study on Sequential Invasive-noninvasive Mechanical Ventilation on Severe Asthma

目的:对比分析有创、无创序贯机械通气策略与单纯有创通气治疗重症哮喘的疗效。方法:80例重症哮喘患者随机分为治疗组(在经口气管插管、机械辅助呼吸治疗72 h后改为无创通气)和对照组(经口气管插管、机械辅助通气)各40例,连续治疗6 d后比较两组氧动力学指标、有创通气时间、总机械通气时间及发生呼吸机相关性肺炎(VAP)的例数。结果:治疗组氧动力学各项指标均明显优于对照组(P<0.05);治疗组有创通气时间、总机械通气时间、发生VAP例数、重新插管例数均显著少于对照组(P均<0.05)。结论:有创、无创序贯机械通气治疗重症哮喘较单纯的有创机械通气疗效更优。

Objective： To evaluate the sequential invasive-noninvasive mechanical ventilation in treatment of severe asthma. Methods： 80 patients with severe asthma were randomly divided into control group and treatment group, and each group was 40 cases. Both groups were received baseline treatment and the endotracheal intubation with mechanically support ventilation. Then the mode of ventilation was changed into the noninvasive mechanical ventilation after 72 hs in treatment group, and the primary treatment maintained in control group. The parameters of blood gas analysis after 6 days and the duration of invasive ventilation, total duration of mechanical ventilation and incidence of ventilation associated pneumonia（VAP） were compared between the two groups. Results： Each parameters of oxygen dynamics in treatment group were significantly better than those in control group （P〈0.05）.The duration of invasive ventilation, total duration of mechanical ventilation, incidence of VAP in treatment group were less than those in control group （all P〈0.05）. Conclusion：The sequential invasive-noninvasive mechanical ventilation has more reliable effect than simple invasive mechanical ventilation on treatment of severe asthma.